HCV‐HIV co‐infected patients: no longer a ‘special’ population?

Prior to the advent of safe and highly effective hepatitis C virus (HCV) treatment, patients with human immunodeficiency virus (HIV)/HCV co‐infection were referred to as a ‘special’ population. This definition was based on more rapid HCV disease progression in the presence of HIV co‐infection, limited effectiveness of interferon‐based HCV treatment and potential drug interactions between medications used to treat HIV and those to treat HCV infection. Although the availability of interferon‐free, oral direct‐acting antivirals (DAAs) has dramatically increased the effectiveness of HCV treatment in patients with HIV co‐infection, this population still warrants special consideration. Specific issues for the treatment of patients with HIV/HCV co‐infection in the era of oral DAAs include a high HCV disease burden with ongoing HCV infection and re‐infection following successful treatment, frequent drug interactions that must be carefully evaluated and unanswered questions on the role of shorter HCV treatment durations.